Fig. 663
Enucleation of a portion or all of the prostate by use of the index finger. (Proust.)
Fig. 664
Hemisection of prostate, each half being secured within the bite of vulsellum forceps. (Proust.)
The balance of the procedure must depend on the size and character of the growth. To strip off a naturally adherent capsule is quite easy, but to detach one which has become firmly adherent through old inflammation or cancerous infiltration is sometimes extremely difficult. Thus enucleation may sometimes be effected in two or three minutes. The stripping and enucleating process should be carried around the prostatic enlargement and into the bladder, and the effort should be to make the smallest possible rent in the vesical mucosa, as well as to separate prostatic tissue from around the urethra rather than to tear or mutilate the latter. Experience and patience will permit the accomplishment of this to a surprising degree. Morcellation may be an aid in removing large masses, and no hesitation should be felt in dividing a mass of tissue which does not come out easily through the wound ([Fig. 665]).
Fig. 665
Prostate removed by the perineal route: A, lateral lobes; B, intravesical growth particularly obstructing urethral entrance. (Proust.)